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TABLE OF CONTENTS
5

Introduction
I.

II.

Policy and Advocacy

7

A. What is a policy?

7

B. What is advocacy?

8

C. What are coalitions and constituents?

9

Bringing Policy Development Forward

I I

A. Roles in advocacy and policy development.. I I

B.

III.

BCC principles and tools be used for
advocacy and policy development

.

14

C. Is policy development work appropriate
for your organization?
.

15

Steps in Policy Development

19

A. Identifying problems

20

B.

Issues and solutions

24

.

C. Gathering and analyzing data

.

27

D. Developing the policy recommendations .... 32

IV.

Advocacy for Policy Adoption

37

A. Doing the advocacy work

37

Results of advocacy

40

B.

Policy and Advocacy in HIV/AIDS Prevention

I

Table of Contents

V.

The Final Stages

................

A. What to expect along the way
B.

Preparation and presentation of policies

C. Implementation and oversight

43
43

44
44

Policy and Advocacy in HIV/AIDS Prevention

2

GLOSSARY
AIDS

Acquired Immune Deficiency Syndrome

BCC

Behavior Change Communication

HIV

Human Immunodeficiency Virus

IEC

Information, Education, and Communica­
tion

STD

Sexually Transmitted Disease

STI

Sexually Transmitted Infection

Policy and Advocacy in HIV/AIDS Prevention

3

J

Intr

ti n

Sb
Wk

INTRODUCTION
Whenever HIV/AIDS program managers and staff discuss some of the

problems they face, someone is likely to say:

’’Well, that’s a policy problem!1'

Another person is likely to add:
“If only policy makers would do something, the problem will be solved.”

People who make these statements may not understand that they them­
selves can inform and influence policy.This handbook provides suggestions

for getting involved in policy development. It is written for program manag­
ers and policy advocates and others who are interested in advocacy work
and in the policy aspects of HIV/AIDS prevention.

The handbook provides an overview of how to contribute to making policy

an effective component of HIV/AIDS prevention.

As with any guide, the words on paper here must be adapted to real life and
local situations.The following points may help make the transition:
1) The handbook illustrates the process of policy development. Readers

must adapt the guidelines to their own experiences and the political

dynamics of their country and organization.
2) The handbook is written from the perspective of someone like a
program manager—that is, someone outside of the normal policy
making structure, but whose work is regularly influenced by the
presence or absence of policy.

Policy and Advocacy in HIV/AIDS Prevention
S

Introduction
3) The amount of work required in overall policy development is
extensive and often intense. No one person or organization can do
everything connected with policy development. Find and work with
collaborators. Some will be more skilled at data analysis, others will
have experience in preparing recommendations or legal language, and
still others will be comfortable interacting with policy makers.

In addition to this handbook, other AIDSCAP BCC handbooks that
may be of interest to the reader are:

How to Create an Effective Communication Project
Behavior Change Through Mass Communication

How to Conduct Effective Pretests

Assessment and Monitoring of BCC Interventions
How to Create an Effective Peer Education Project
HIVIAIDS Care and Support Projects

Partnership with the Media

BCC for STD Prevention

Policy and Advocacy in HIV/AIDS Prevention
6

Section I

A

v^wwBWrll JMBP

Policy and
Advocacy

rt>
n

§

POLICY AND
ADVOCACY
This section defines and gives some examples of policy and advo­

cacy. In fact, both terms are often used in various ways, depending

upon local experiences. Organizations that develop policies for
their internal use or that seek to influence policy development
outside of their organization will want to have a common under­
standing of the terms.

A.

What is a policy?

A policy is a framework which guides decision making in an organization
or government. It is a statement of intended action. For example:
► a business may have a policy of non-discrimination for hiring and

employing people who are HIV-positive.

► a NGO may have a policy that directs its choice of target groups.
► the government is likely to have a policy that outlines the qualifica­
tions of teachers.
Policies deal with matters of daily life (e.g., the time employees are
expected to report for work) and also major issues for society as a
whole (e.g., inclusion of HIV/AIDS education in school curricula).

The HIV/AIDS epidemic has created the need to think and act in new

ways which may require new policies to deal with the new situations.
For example, policies may be needed to deal with issues such as:
► condom availability for all sexually active people
► confidentiality in HIV testing
► reducing school fees for orphans
► hiring HIV positive employees.

Policy and Advocacy in HIV/AIDS Prevention
7

Policy and Advocacy

Governments, businesses and religious organizations all have policies.
Even a small NGO may have policies.

Policies can take various forms:

► they may be general statements about national or organizational
priorities.
► they may be written regulations.
► they may be guidelines, procedures and/or standards to be achieved.
► they may be informal (or unwritten), but widely recognized practices.
B. What is advocacy?

Advocacy is an organized effort to influence decision making. People
who attempt to inform decision makers and to influence their decisions
are called advocates. Advocacy is also called lobbying or campaigning.
Whatever its name, it means that people are making planned efforts to
influence a decision.

For example, many NGOs are anxious that their governments adopt
policies to teach some form of sex education in schools. As a part of
their advocacy efforts, several NGO coalitions have publicized the
results of surveys that show high levels of youth sexual activity. As a part
of their advocacy strategies, the coalitions expected the data to sensitize
government and religious policy makers and parents’ groups to a critical
situation.The coalitions accompanied presentation of the survey results
with specific recommendations for introducing sex education into
school curricula.

The goal of an advocacy campaign is to convince decision makers to act
in favor of your issue or cause.The advocacy message is a brief, clear
statement of the problem and a recommendation for its solution. It can
be delivered personally in meetings with decision makers, or in the form
of posters, banners, fact sheets, newspaper columns, newsletters, or
radio and television announcements, etc.

Policy and Advocacy in HIV/AIDS Prevention

8

Policy and Advocacy
Advocacy groups have at least three useful roles in the policy making

process:

► They alert policy makers to problems and concerns of the people
they represent.

► They provide potential solutions (or options) to those problems.
► They can support policy makers on issues of mutual concern.
Examples of groups which might do advocacy work are:

► an employers’ federation
► academics
► a union representing workers

► a NGO coalition
► a public health association.

C. What are coalitions and constituents?
Coalitions

Formal coalitions are groups of organizations which share a common

goal and demonstrate support for (or against) a proposed policy.The

larger the coalition, the greater its ability to bring issues to policy
makers. Some coalitions (such as a national trade union federation) may
represent thousands of members.
Informal coalitions arise from personal contacts and shared interests

and felt needs. For example, when one African country worked to

develop a national HIV/AIDS policy, an informal alliance of a few lawyers,
key civil servants, major NGO staff, select academics, and some interna­
tional donors occasionally worked together to move the process along
more quickly.
Coalitions may form specifically to express common support for an
issue. When the issue has been resolved, the coalition generally disbands
or is reformed as new issues come forward.

Policy and Advocacy in HIV/AIDS Prevention
9

Policy and Advocacy
Constituents

Policy development is often guided by a core group of activists who
speak for and represent a much larger group of concerned people.That
large group is the constituency of the activists.They are constituents.
For example, a coalition formed to work on HIV/AIDS issues might
count among its constituents, people who are vulnerable to HIV
infection, people living with AIDS, health and development workers and
others who are in some way concerned about this particular issue.
Both the core group that guides the policy development process and the
wider constituency play important roles in policy development and
advocacy.

Policy and Advocacy in HIV/AIDS Prevention

10

A.

Section II
w

Mew 3

Bringing Policy
Development Forward
</)
n

BRINGING POLICY
DEVELOPMENT
FORWARD
A.

Roles in advocacy and policy development
Policies are not made just by members of parliament or church coun­

cils—people who are policy makers.They often result from the efforts
of many groups and their constituents who encourage, persuade and put
pressure on the policy makers. We refer to these people as policy
influencers—they provide the technical expertise, field experience, and

advocacy efforts which inform and persuade policy makers to act.
If your organization wants to work for policy development, you should
plan on working with many of the people or groups listed below:
1. program managers and staff

2. technical specialists, analysts, planners, advisors

3. coalitions (alliances)

4. media
5. communities, including people infected and affected by HIV/AIDS
6. policy makers.

Policy and Advocacy in HIV/AIDS Prevention
I I

Bringing Policy Development Forward

I. What can program managers and staff do?
Program managers and program staff have important roles in the
development of HIV/AIDS prevention policies.

► First, because they are close to communities, they can identify HIV/
AIDS/STI issues and assist in documenting the prevalence of particu­

lar problems and thus provide an information base for developing or
revising policies.

► Second, they can bring issues that affect their target audiences to the
attention of policy makers. Using behavior change communication
(BCC) principles and tools, they identify the crucial influencers and

decision makers, select appropriate channels to reach those individu­
als and plan creative and powerful approaches to get their messages

to them.

► Third, they can join or build coalitions which can demonstrate
collective concern about an issue.

► Fourth, as policies are being created, they can publicly show their
support for their adoption.

► Fifth, field staff and program managers may eventually implement
activities in the context of adopted policies. So, they can help shape
how policies are applied and offer feed-back for policy makers.

2. What can technical specialists, analysts, planners and advi­

sors do?
As policy influencers, specialists and analysts can use their skills to
collect and present data about the issues or use their expertise to

suggest options for addressing the issues.Technical experts include the
statistician who compiles for the district medical officer data to show

monthly trends in STD cases and the medical doctor who has just
returned from an international conference.
Advisors to policy makers are important policy influencers. Often, they

have direct access to policy makers, or provide them with critical
information, and may even recommend actions for the policy makers to

take. Advisors to policy makers can include the president of a large
women’s organization, or a university professor who is known for his
interest and expertise on this issue, or the editor of a daily newspaper.
Policy and Advocacy in HIV/AIDS Prevention

12

Bringing Policy Development Forward

3. What can coalitions do?
Coalitions are groups of people or organizations that share a common

concern and agree to work together to achieve a common goal. Coali­
tions may be temporary alliances formed to influence a specific decision.
Or, they may be long-term, designed to exist for years.They are neces­
sary for creating and sustaining political will and commitment for a new
policy because they can:
► mobilize large groups of people
► represent the interests of many groups
► increase the power and influence of advocacy efforts.

4. What can the media do?
The mass media can create public awareness about the need for a policy

or the existence of a bad policy. It can also target decision-makers and
interest groups with information about the policy issue.
► Print media: As literacy levels increase, the print media gain greater
importance in informing people. Articles written by authorities,

letters to the editor and editorials can influence many readers,
including decision makers.
► Broadcast media: Radio and television have a large outreach and

can play a direct role in advocacy with the general public. For
example, televising the involvement of the head of state or other
dignitaries in an HIV/AIDS prevention event can emphasize the

national importance of HIV prevention.

Policy and Advocacy in HIV/AIDS Prevention

13

Bringing Policy Development Forward
5. What can communities do?

Community leaders and members are often the key to successful
advocacy work and policy development.Their involvement is crucial
because they can:
► arouse public interest and awareness of HIV/AIDS issues in the
community
► build interest and support at grass roots level
► make a call for action
► apply pressure to gain support from politicians.

6. What can the policy makers do?

Policy makers sometimes make policies themselves, but often they are
not aware of particular problems or gaps in existing policy.Therefore,
the policies they adopt are often based on the ideas and concerns of the
groups and individuals discussed above. Also, policy makers may:
► be leaders in shaping public opinion
► act when they recognize a problem
► build support for implementation of policies.
B.

BCC principles and tools for advocacy and policy development

Behavior Change Communication’s (BCC) role in HIV/STI programs is
to help change, or reinforce, decisions and behavior related to preven­
tion and care.The principles and tools of IEC/BCC are useful to advo­
cacy and policy development in a number of ways. For example, BCC
approaches are useful:
► to heighten awareness of HIV/STIs as a national issue among policy
makers and the public.
► to contribute to a favorable political and social climate for HIV/STI
prevention and care.
► to mobilize the community and relevant social organizations for
prevention and care.

Policy and Advocacy in HIV/AIDS Prevention

14

Bringing Policy Development Forward
► to popularize technical information about prevention and care.

► to deal with specific community problems through appropriate
messages and media directed at identified target audiences.

The same principles that you use to encourage and support behavior
change in your target group can be used in effective campaigns aimed at
policy makers. For example, if you intend to do advocacy for policy
development you will:
► carefully define the audience(s) who need to hear your messages.
► conduct research to learn about the issue/problem .
► conduct formative research to help you understand policy makers’
current positions.
► craft messages which appeal to the concerns and beliefs of the
targeted policy makers.
► use interpersonal, print and broadcast media to reach them.

You will also use some policy tools which will be discussed in Section 3-C.

C. Is policy development work appropriate for your organization?

Involvement in policy development around certain issues is not appro­
priate for all organizations.Think carefully to decide whether policy
development work is the best use of your organization’s time and
resources.Answers to the following questions may help you decide.

The Issue

► Is there a barrier that is preventing your organization from reaching
its goals?
► Who or what has created the barrier?
► Is this a problem only in your organization? Or is it in the wider
community? Is it a national problem?
► Can the problem/issue be resolved without developing and imple­
menting a policy?
► Would a new policy be useful? How?
Policy and Advocacy in HIV/AIDS Prevention

15

Bringing Policy Development Forward
A Coalition
► Is there an existing network or coalition established to deal with

problems of this kind? If not, are there other people or groups who

are concerned with this issue?
► Have they had a meeting to discuss their concern? Are they doing

anything to overcome it? Can you join them?
► Do you believe that a strong coalition can be established? Who will

get it going? Who will keep it going?
Your Organization
► Is this issue really relevant to your goal and to your program’s target

audience(s)?
► Are you aware that policy development may take one year or more?
► Do you have staff members who have the time and interest to
contribute to policy work?

► Do members of your staff have BCC skills? Outreach skills? Organiz­
ing skills?

► Can you allow these people to contribute some of their time and

skills to the coalition?
► Do you have resources to contribute for this policy intervention—
for example, money, material, special skills, contacts in the media, the
academic world, the technical world or with decision and policy

makers themselves?

If you have (I) identified an issue that requires a new or better policy
and you are (2) prepared to put the time and resources into advocacy
work for the development of that policy, you will still want to consider
the table below before committing your organization to policy develop­

ment work.

Policy and Advocacy in HIV/AIDS Prevention
16

Bringing Policy Development Forward
Spending time, money and effort to influence policy development is not

always practical or appropriate.The table below indicates occasions

when you should consider working to develop a policy and when you

should not.
DEVELOP A POLICY

DO NOT DEVELOP A

WHEN

POLICYWHEN

an issue effects an entire country
or organization or a large segment

a policy already exists e.g.,some public

of the population

health policies sufficiently cover HIV/
AIDS issues

there is a clear need for organiza­

a problem can be resolved through

tional guidance on acceptable

existing administrative or management

behavior

channels.

there is no consistent way of

the time and resources required to

dealing with an issue; it is dealt
with differently every time it

develop a policy far exceed the
capacity of your organization or

occurs

coalition

resources are not distributed to
benefit everyone

circumstances are so unfavorable that
there is a serious risk of a negative
response

a new situation arises which
requires special consideration

regularly followed procedures already
fit most people’s needs.

greater attention to this issue will
bring real benefits

Policy and Advocacy in HIV/AIDS Prevention
17

Bringing Policy Development Forward

Not all problems have a policy solution. For ex­
ample, some problems can be overcome through
training or by better management. Even if develop­
ing a policy is the best solution, the policy won’t
solve the problem if it is just a ’’paper policy".
For example, a country may, as a matter of policy, set up a National AIDS
Control Program (NACP) to monitor the epidemic and coordinate
prevention and patient care programs. But if the NACP is understaffed,
has vague guidelines, or lacks an adequate budget, the national policy will
not be useful to managers and staff involved in prevention and care
activities.

Remember:
You may have to make extra efforts—such as adding
to the workload of some staff, finding new money to
support the effort, building relationships with new
organizations—to do advocacy and policy develop­
ment work.

Policy and Advocacy in HIV/AIDS Prevention

18

Steps in Policy
Development

Cft

ft

STEPS IN POLICY
DEVELOPMENT
The steps outlined below are parts of the process for effective policy
development. As parts of a process, the various steps tend to blend
together in real life. Some parts will require more time and effort than
others.Within a coalition, some organizations or individuals will be
better prepared to handle some parts of the process than others.
The following diagram indicates the links between the steps outlined
here.

Implementation

Identifying Problems

Policy Adoption
Issues and Solutions

Policy Language

Gathering and Analyzing Data

Advocacy

Policy Recommendations

Policy and Advocacy in HIV/AIDS Prevention

19

Steps in Policy Development
A.

Identifying problems
If you believe that a new policy is required, you must also believe that
there is a problem that can be solved by the policy. Policy development
begins with a problem.

Collecting Problems
Identifying problems for implementation of HIV/AIDS/STI prevention

and care programs is easy if you work with an HIV/AIDS/STI agency. For
example,

► You may know that many young people have no understanding of

their bodies and reproductive matters.
► You might understand that commercial sex workers are afraid to go

to public clinics for STD treatment because they might be turned
over to the police.

► You might be concerned that condoms are only available in pharma-

cists/chemists shops.

► You might disagree with an existing policy that deals with care of
orphans.

You, your staff, and others you work with in the HIV/AIDS/STI field will
recognize many problems. Some may have policy solutions.

Collect problems from a variety of people and interest groups to get a

variety of perspectives.

Keep a list of identified problems and note how frequently they are
mentioned. A simple list of the problems and how often they are
mentioned is an easy way to get a sense of how critical problems are.
On the next page is a sample table illustrating the HIV/AIDS prevention
and care problems that one program manager recorded.

Policy and Advocacy in HIV/AIDS Prevention

20

Steps in Policy Development

Sample:

Problem

Number
of
Mentions

medical staff, clients

I. HIV test kits are out-dated and not
accurate
2. Many people seem indifferent to

Groups
Affected

5

health educators,
program managers

prevention messages

3. Men don’t like to use condoms

2

general

4. There are not enough resources to

7

AIDS patients, medical

care for everyone with AIDS
5. There is lack of leadership by policy

staff

4

6. Some businesses informally require

program managers,
MOH staff

makers

3

workers, lawyers

5

women’s groups,

HIV testing of employees
7. Cultural practices, such as male

promiscuity, spread HIV

religious leader

10

general

8

medical staff, clients

10. Home care training is inadequate

2

medical staff

I I.Religious opposition to sex
education for youth

7

program managers,
MOH and MOE

8. Women lack power to protect
themselves

9. Drugs are not available to treat

STIs and many illnesses related to
HIV/AIDS

officials
12. Projects are too scattered and
uncoordinated

2

NACP

Policy and Advocacy in HIV/AIDS Prevention

21

Steps in Policy Development
Sorting Problems
Sorting is necessary if the list of problems is long. Choose the ones that
your group (and others who will join you) are best equipped to handle.

Also consider:
► the number of times the problem was mentioned by the people you

talked to.
► the method of resolving problems (e.g., through management

improvements, through logistics changes, through policy develop­
ment).
► how the problems compare with national or organizational priorities.

Prioritizing Problems
You may need to reduce the list of problems to a workable number.
Some organizations work on one major problem for months or years

while also working on two or three minor problems for shorter periods

of time.
There is no one correct way to prioritize. Among the questions to ask
when preparing a list of priority problems are:
► Do we have the experience and background to learn more about the

problem?
► Do we have the interest and the resources to keep working on this

issue until a policy has been developed?
► Will the creation of a policy make a difference in resolving the

problem(s)?
► Does there seem to be interest about the problem among policy
makers, constituents and other groups?

As you make formal and informal contacts with coalition partners, other
policy influencers, managers, and perhaps some policy makers, the
answers to the questions will become clear.

Policy and Advocacy in HIV/AIDS Prevention

22

Steps in Policy Development
EXAMPLE: Prioritizing Problems

Fifteen (15) problems were identified during interviews and
meetings in the community and with service providers.The first
sorting reduced the number to ten (10) and a second sorting left 4
problems.

Each of the 4 problems were considered important; however, the
coalition does not have the staff or other resources to work on all
4 problems at once. Despite strong support for each of the prob­

lems, the coalition decided to devote its major effort to just one
problem.

The problem selected was: “Women lack power to protect them­
selves.”

The coalition decided on this problem for several reasons:
► It was most often mentioned during the problem gathering
survey.

► Women’s, development and legal reform groups were working
on similar issues and might be willing to add their support for

policy change.
► There was extensive experience among coalition partners in

working with local women’s groups.

Policy and Advocacy in HIV/AIDS Prevention

23

Steps in Policy Development

B.

Issues and solutions
Turning Problems into Policy Issues

When you have selected one or two priority problems, you want to
express them as an issue. Forming an issue statement helps you to focus
on reasons for the problem and therefore helps you think of possible
solutions.

► A problem is a statement of an unsatisfactory situation.
► An issue is also a statement, but it focuses on the causes of the
problem and suggests the direction to look for a solution.
For example:

Problem
Statement

Orphans in this community are not going to school.

Issue
Statement

Because of poverty and stigma, orphans often are
excluded from school.

Problem
Statement

Young adults don't understand the risks of unprotected
sex.

Issue
Statement

Many youth are sexually active but do not have the
information that is needed to practice safer sex.

Problem
Statement

Some pregnant women are refusing to attend antenatal
clinics because they are afraid that their blood will be
tested for HIV without their knowledge.

Issue
Statement

Ante-natal care is hindered because many pregnant
women have misinformation about the reasons for
HIV tests and because test results have not always
been kept confidential.

Policy and Advocacy in HIV/AIDS Prevention

24

Steps in Policy Development

There may be several solutions to any one problem/

issue. Some problems can be solved by changes in
program content or operations. For example,
number two above might be solved by developing,

producing and disseminating risk assessment
messages to young adults. However, if teachers and

religious leaders do not allow young people to have
access to such information, a policy solution might
also be required.

EXAMPLE :Turning Problems into Issues
We selected the problem that was mentioned most often in the
table in Section 3-A: women lack the power to protect them­
selves from HIV infection.

During our discussions with staff, community members and other
NGOs, we find that there are many reasons why women lack
power and are vulnerable to HIV infection. Many possible solutions

are offered. We prepare an issue statement which both expresses
the problem and suggests a policy-based solution.The issue state­
ment reads:
Women are vulnerable to HIV infection because they lack

the skills and the power to engage in dialogue about sexual
matters with their partners.

Selecting a Solution
After a problem is expressed as an issue statement, work with your
coalition partners to decide on a workable solution.

Not all problems have a policy solution. Since you
believe that this is a serious problem and you
sincerely want to solve it, consider all solutions.

Policy and Advocacy in HIV/AIDS Prevention

25

Steps in Policy Development
In order to determine an appropriate solution, you and your coalition
partners will want to gather and analyze as much information as possible
about the issue (see next section).Then brainstorm as many potential
solutions as you can think of. Examine each one and consider the
probability that people will be willing to organize around and support
that solution.

If you believe that development of a new policy may be an appropriate
solution, consider the following things before making a final decision.

► Will enough people and advocacy groups be interested in this
solution so that we can bring it to the attention of all key decision
makers?
► Is this issue so sensitive that policy makers will not want to deal with
it in the current political atmosphere?
► Are there past examples of people or organizations trying to push
for such a policy? What happened? Could the same thing happen to
this coalition?
► What are the chances of achieving success?

► Is the information that we have available strong enough to persuade
policy makers?
► Are there other and easier ways to solve this issue?
► How many decision makers must be convinced in order for this
solution to be taken seriously? Do we have the staff and resources to
reach all those people?

► If a policy is developed, is it likely that it will be implemented and
enforced?
► Will a new policy make a real impact on this problem?

Policy and Advocacy in HIV/AIDS Prevention

26

Steps in Policy Development
EXAMPLE: Selecting a solution
We now have the issue statement (’’Women are vulnerable to HIV

infection because they lack the skills and the power to engage in

dialogue about sexual matters with their partners/*), but there are

still many possible policy options that can be used to address the
problem. We can’t realistically follow all the options. It is necessary
to pick one option and work on that.

We believe that communication between married women and men
can improve with the support of capable and trusted institutions.
Religious groups in our district are trusted and have experience in

promoting communication.Therefore, we decide to focus our policy
work on religious groups. We will advocate that all religious
denominations adopt and implement policies which promote
communication within families.

C.

Gathering and analyzing data

In order to influence policy makers you must give them information that
clearly indicates the problem and supports the solution that you suggest.
Data do not have to be highly complex or require a lot of mathematical

analysis.The purpose of the data is to (I) demonstrate a problem and

(2) support a credible recommendation.

For example, the host of a radio call-in show for youth noted during a
casual discussion that many of the callers had questions about sexuality

and sexual relations. It was suggested to her that by asking a few
questions of each caller about their gender, age, school status, and sexual
behavior she could develop a profile of youth sexual behavior in just a

few weeks.The results could be used to sensitize policy makers to
support a recommendation for school or community-based sex educa­
tion.

Policy and Advocacy in HIV/AIDS Prevention

27

Steps in Policy Development
First, find out if information needed to support your policy development

is already available.The table below shows the type of information you

might find.

AGENCY

INFORMATION

National AIDS Program

epidemiological data; existing policies
and guidelines

Medical and Public Health schools

specialized studies

at universities
Economics, Political Science and
Development Studies departments

economic, policy or similar studies

at universities and institutes

Other organizations involved in

comparative field experiences

HIV/AIDS prevention and care

impact studies or related advocacy

Business and NGO coalitions

efforts
International donor agencies,

comparative international examples

UNAIDS, and international NGOs

If the information is not available, you will need to gather it.The tools

you need will depend on the issue and the type of information needed
to make the problem clear.

I. Surveys, questionnaires and interviews
Surveys, questionnaires and interviews are useful tools for gathering

data. Ask local experts (e.g., academics, technical specialists in govern­
ment and NGOs) for guidelines and assistance in gathering additional
information. Often university students under the supervision of a
professor will undertake this kind of research and analysis. Or, trained
members of your coalition might also do it.

Policy and Advocacy in HIV/AIDS Prevention

28

Steps in Policy Development
You may want to ask researchers to conduct a survey among e.g.,
secondary school students to determine to what extent they are
already sexually active. In another case, key informant interviews with

health workers might be enough to illustrate the problem that you are
trying to solve. In a third case, questionnaires filled in by STI patients in a
waiting room might give you the information you need to focus on a

quality of care issue.

Remember:
Program managers themselves do not have to know

how to use the next four policy tools. But they do
have to know that such tools exist and how they can
be used to assist in policy development.Technical

specialists may be able to actually use the tools
when appropriate.

2. Policy assessment tool

An assessment of HIV/AIDS policy can be applied to countries, to one
or more sectors of society, or to an organization. Assessments aim to:
► determine existing policies and gaps in the policy structure.
► identify emerging issues.

► identify individuals and groups involved in and capable of informing
and influencing policy development.

► understand the policy making process(es).

Who can help?
Specialists capable of conducting a policy assess­
ment may be found in the Political Science,
Sociology, Management, or Development Studies

departments of universities. Independent research
centers may also have experience with this form
of qualitative data gathering and analysis.

Policy and Advocacy in HIV/AIDS Prevention

29

Steps in Policy Development
Information for a policy assessment comes from key informant inter­
views (policy makers, technical and program specialists, activists, people
affected by policy or its absence); unpublished reports from government,

NGOs, academics and international donors; and books and published
reports.

Normally, a report will be prepared that presents the results of the
policy assessment. Recommendations may be included.

3. Epidemiological modeling tool

It is possible to prepare a profile of the current and future status of the
HIV/AIDS epidemic. Existing HIV,AIDS and STDs data can be analyzed

to make an estimate (or projection) of the likely course of the epidemic
for 2 to 5 years into the future. Computer software is used to produce
the projections. However, the projections are only as accurate as the
data that is used with the software.Two basic modeling software

packages—Demproj and Epimodel—are frequently used to make short­
term (3-4 year) projections. Analyses from these programs can be used

in a software package (the AIDS Impact Model—AIM) that presents the

results in graphical terms.
Other software packages give longer-term projections, but require more

complex data sets. SimulAIDS is an example.

Who can help?

People capable of analyzing data for modeling can
be found in many National AIDS Control Pro­
grams, in the Epidemiology units of Ministries of
Health, in Statistics or Mathematics departments

at universities.

Policy and Advocacy in HIV/AIDS Prevention
30

Steps in Policy Development

4. Socio-economic impact assessment tool
The epidemiological projections can be complemented with
economic data to provide an estimate of the costs of HIV/AIDS to a

national economy, a specific sector, or an organization.These
projections estimate costs directly associated with HIV/AIDS—such
as combined hospital and clinic costs of treating and caring for

people with HIV/AIDS.The projections can also use data that deal
with indirect costs, such as income lost to a business when employ­

ees are absent due to HIV/AIDS. Refinements in the methodology
now permit estimates of the economic impact on communities and

indicate the impact on women or children.

Who can help?
Economists, some sociologists and management

specialists will be able to do the analysis involved
here. University departments and research
centers will be good sites for seek assistance.

5. Business impact assessment tool
The impact assessment methodology can be adapted to estimate
the annual costs a business may encounter due to HIV/AIDS among
its employees. A complementary aspect of the methodology permits

businesses to compare HIV/AIDS losses with the cost of developing
and running a prevention program in the workplace.

Who can help?
Business management, Economics,Administration,

and Sociology departments at universities and
management training institutes probably have
qualified staff to assist here.

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Steps in Policy Development
EXAMPLE:Tools for Gathering and Analyzing Data
We ask the district medical officer and the National AIDS Control
Program for epidemiological data on HIV prevalence in the district,
broken down by age and gender (if possible). Although somewhat
incomplete, the data show that half the AIDS cases in the district
are among women and nearly 14% of women attending antenatal
clinics are HIV-positive.The NACP sent a pamphlet which showed
that HIV rates in the country could reach nearly 20% of the adult
population within five years without more effective prevention
programs.

A survey found that over two-thirds of married women reported
being worried about HIV infection, especially from their husbands.
Nearly the same percentage of women reported that sex with their
husbands sometimes involved coercion or threats of violence. Only
10% reported that they and their husbands have discussed use of
condoms.
An assessment of religious groups represented in the district found
that all of the groups had policies promoting family relations and
respect between family members. Nearly 90% of the religious
groups said that clergy provide counseling to people in their
congregations. However, only 40% of the clergy and laity leaders had
received training in counseling and communication skills.

D.

Developing the policy recommendations

Preparing the background information report
Prepare a report for use by coalition partners based on the information
collected.This report will provide all the background information in
support of the policy recommendations that you are going to make. It
provides the rationale for the policy you support. It will also be the basis
for the activities, the messages and the channels that are used during the
advocacy phase of policy development work.

Policy and Advocacy in HIV/AIDS Prevention

32

Steps in Policy Development

The report usually includes short sections on:
► the statement of the problem

► the methodology for data collection
► a presentation of the data, and
► a discussion of the results.
Developing and writing the policy recommendation

A policy recommendation is a formal statement, expressed in clear,
concise and objective language. It usually includes the following ele­
ments:

► Statement of the problem and/or issue, and for whom and why the
problem exists.
► Background and supporting information which demonstrates the
problem (this will be drawn from the report, noted above).
► A description of the policy context into which the recommendation

will fit.
► The recommended policy to address the problem.
► Any additional rationale for the recommendation (i.e., ’’the policy will
provide guidance to health workers in giving quality care and treat­
ment to people living with HIV/AIDS.“).

The policy recommendation will be distributed to policy makers and
their staffs as well as all the active members of the coalition so that they
will be well informed and ready to be involved with advocacy work. It is
a much shorter document than the background information report (see

example at the end of this section).
Here are some hints for writing a policy recommendation.
► Do not use words such as ”must“, ’’need to“, ’’should" when refer­

ring to actions to be taken.These words do not provide practical
guidance on how the policy can be achieved or how the policy will

alleviate the problem it is designed for.The words allow people to
agree, without committing to act.They may also be seen as demands
by some people, and thus will be resisted.

Policy and Advocacy in HIV/AIDS Prevention
33

Steps in Policy Development

► Avoid making a recommendation that is too general or unattainable.

For example, a recommendation to end poverty is both too general
and unattainable in the near future.
► Keep the policy statement relatively short.The overall policy recom­

mendation will be 1-3 pages in length. People who need further

information can review the background paper and related informa­
tion.

EXAMPLE: A Brief Policy Recommendation to Reduce the

Vulnerability of Married Women to HIV/AIDS
(Statement of problem) The HIV/AIDS epidemic in our country and
our district is a matter of great concern. Despite government and

NGO programs to inform citizens and promote safe sexual rela­
tions, HIV infection rates are very high. In this district, nearly one in
seven (14%) women are HIV-positive. Many of these women are

married, but became infected by their husbands.

(Background and supporting information) Most women are very
concerned about HIV infection.They are worried that the sexual
behavior of their husbands either before marriage or during

marriage brings the risk of infection for the wife. Only 10% of
married couples in the district discuss sexual issues. Many women
feel they have little control over the sexual behavior of their
husbands and feel very vulnerable to HIV infection.

(Policy context) Religious groups are important institutions in the
district. All support strong family relationships. Most have become
aware that HIV/AIDS is an issue for religious communities. ”We are
burying too many of our people/* said one clergy leader. Religious

institutions are in a strategic position to support women to protect
themselves from HIV infection.

Policy and Advocacy in HIV/AIDS Prevention
34

Steps in Policy Development
(Policy recommendations) To help prevent the spread of HIV/AIDS
among women and men in the district and the country, it is recom­
mended that all religious institutions in the district adopt and
implement the following policies:
1) Affirm the right of women within marriages to be safe and secure
in that relationship.

2) Build upon the strength of religious groups in promoting commu­
nication within families by offering counseling on inter-personal
relations, including sexual relations, and dialogue for couples
planning to marry, newly married couples and all married couples.
3) As a matter of urgency, introduce training on sexual relations and
couple communications into the curricula and refresher courses
for all clergy.

4) Allocate the necessary resources to support the training of clergy
and of their work with community members on couple communi­
cation, even if resources must be drawn from other work of the
religious groups.
Adoption of these policies will require the careful and thoughtful
consideration of each denomination and religious community. Often,
such deliberations take many months or years. However, the crisis
of HIV/AIDS requires that our religious groups act quickly.We hope
that clergy training can begin within three months, and couple’s
counseling and dialogue can begin within six months.

Policy and Advocacy in HIV/AIDS Prevention

3S

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Advocacy for
Policy Adoption

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ADVOCACY FOR
POLICY ADOPTION
The use of advocacy to achieve policy results is a continuation of
the process of developing the policy issues and
recommendation(s). Advocacy becomes a part of the policy
development process when there is a need to inform policy mak­
ers, generate interest within the general public, and expand the

constituency for the policy.

A.

Doing the advocacy work

The core group activities
Policy development and advocacy are often guided by a core group of

committed individuals. Usually, this small group (rarely more than 10-12

people) develop the main strategy, prepare written materials, arrange
meetings and take part in meetings with policy makers.They also
provide day-to-day leadership for advocacy efforts.
One of the most important ways to reach policy makers is to arrange
meetings with them and their staffs. During these meetings, coalition
leaders discuss the background, present data and the reasons for the

policy recommendation and request the support of the policy makers.
Advocacy activities may occur over several weeks or months. Back­

ground materials can be sent to the policy maker before the initial
meetings. More than one meeting may occur. Following a meeting,
additional materials are sent, with a cover letter thanking the person for
the meeting and referring to the outcome of the meeting, and again

asking for the support of the person.

Policy and Advocacy in HIV/AIDS Prevention
37

Advocacy for Policy Adoption

Coalition and constituency activities

To achieve the adoption of the proposed policy, it is necessary to gain
and demonstrate support for the recommendation. Coalitions do this in
a variety of ways.
Some activists or constituents may have professional or personal
relations with policy makers.They or the technical specialists can often
make contacts with policy makers or with the people who control the
information that reaches them. Although such contacts are planned, they
can appear to occur ’’accidentally"—during a meal, at a bar, between
meetings at the office, or after religious services.
Other ways that coalitions and their constituents bring the issue to the
attention of policy makers are to:
► List the names of all the supporting organizations or individuals at the
bottom of the recommendation itself.

► Organize a complex publicity campaign, with media messages.
► Ask people to sign petitions for presentation to policy makers.
► Get people to attend rallies.
► Pass out information (e.g., leaflets) at large events.
► Hang banners and posters in public places.
► Write letters to the editor.
► Give speeches at local groups’ meetings.
► Prepare and distribute press releases.

► Sponsor public meetings on the policy recommendation.
► Get sports, movie,TV and radio celebrities to become public spokes­
men for the issue.

Policy and Advocacy in HIV/AIDS Prevention

38

Advocacy for Policy Adoption
EXAMPLE: Doing the advocacy work

Because our policy recommendations are aimed at religious
institutions, we need to find ways they may already share informa­
tion with one another.There may be committees which deal with
social issues such as ’’the vulnerability of women to HIV infection
and the need to improve communication among sexual partners.'4 If
so, we would meet with and educate members of these committees.
In addition, advocates who attend religious services, would speak to
both clergy and lay leaders.They might get permission to pass out
leaflets.They would urge clergy to discuss this issue during religious
services.They would also provide them with background informa­
tion and urge them to work for adoption of the policies within their
denominations.They might also encourage the religious leaders to
revise their budgets so that funds will be available to implement
some recommendations—e.g., counseling and dialogue training for
clergy members.

If some religious groups run medical facilities, social welfare pro­
grams, schools, or other community development efforts, staff in
these programs will be approached and brought into informal
coalitions because they may be effective advocates with religious
leaders.

Some members of the core group of activists or the larger group of
constituents may inform political or government leaders because
they can then encourage the religious groups to respond to the
policy recommendations.

Policy and Advocacy in HIV/AIDS Prevention
39

Advocacy for Policy Adoption

B.

Results of advocacy
Policy makers will act when they recognize the problem and agree with
the proposed solution; or when they agree with advocates that a
national or organization problem exists requiring their action; or when
they are convinced action is to their political or economic advantage.
When policy makers are willing to act for these reasons, the work of
advocates can guide and convince the policy makers.

However, some policy makers may act for reasons that do not reflect
the collective good. For example, they may act to block a rival; or to gain
a quick profit or political advantage for themselves or associates; or for
ideological reasons. In these cases, advocates will have a more difficult
time, unless their messages appeal to the self interest of the policy
makers.

Policy and Advocacy in HIV/AIDS Prevention
40

Advocacy for Policy Adoption

EXAMPLE: Results of advocacy
The policy recommendations led to a lot of discussion in the
district, and beyond. Fifteen clergy spoke to the issue and supported
the recommendations during religious services. Several clergy,
however, expressed concern or opposition to the recommenda­
tions.They argued that AIDS was a result of individual sin and even
if women were vulnerable they had to obey their husbands.
A meeting of district clergy leaders started with a fruitful discussion,
but the meeting was disrupted by several men and women who
loudly denounced the recommendations.The confusion that
followed resulted in the meeting adjourning before decisions were
made.

Supporters of the policy recommendations gained strong support
from women’s organizations and NGOs working on AIDS issues. A
coalition of 58 groups prepared a brochure to distribute through­
out the district, urging religious groups to support the recommen­
dations. Opponents of the policies countered with a brochure of
their own that said that sexual matters should be left up to the
couples themselves.
An important point in the advocacy campaign was when the head of
a major denomination spoke in one of the churches. He praised the
district for seeking to strengthen marriage ties and to counter the
AIDS epidemic. He said his denomination strongly supported the
proposed policies. He said that it would take the denomination at
least six months to formally consider and adopt the policies, but he
urged his clergy to begin implementing the policies immediately.

Policy and Advocacy in HIV/AIDS Prevention

41

Advocacy for Policy Adoption

Advocacy efforts may not bring the desired results. Policy makers may
not respond or try to defer consideration of the policy proposals.They
may ask for further studies. For policy advocates, failure to achieve their
objectives can be disappointing and demoralizing. As hard as it may be,
the advocacy partners need to analyze the factors that limited their
effectiveness. As they do that, new ideas are likely to emerge. As gaps
and strengths are identified, a new advocacy strategy or approach can be
prepared.
Setbacks are common in policy development. Changes in strategy often
occur. Advocates may want to re-examine their policy recommendation
to determine if it remains a viable proposal.

Policy and Advocacy in HIV/AIDS Prevention

42

Section

T

The Final Stages

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THE FINAL STAGES
A.

What to expect along the way

Policy development may go smoothly or may face many obstacles.
Efforts which are well planned and organized are more likely to succeed.

Experiences from many countries illustrate things which may occur
during policy development activities.
► Expect active discussion and disagreements as coalition partners try

to define the message and work out an effective strategy.

► Expect that the process of building support for your recommenda­
tions will be labor intensive and time-consuming. Good ideas alone—

even urgent ideas—do not create an organization or a constituency
for issues and policies.

► Expect a dynamic process, with small and big pieces of information,

changes in situations, events and positions all contributing to the mix.
► Expect to be ignored, dismissed, and marginalized.The people you are
targeting with your advocacy messages have many other groups also
demanding their attention and involvement. Until your advocacy
group is known, its position and opinions clear and its ability to
influence demonstrated, policy makers may ignore you and give only

lip-service to the issue(s).
► Expect compromises. Compromise will probably occur when policies
are being adopted and implemented. Compromising on issues which
are considered critical is difficult and can be disheartening. However,
compromises are an outcome of negotiations.

► Expect success. Of course the obstacles are real, but so are the
chances of mobilizing a constituency and conducting effective
advocacy. Success may not be quick and may be gradual.

Policy and Advocacy in HIV/AIDS Prevention
43

The Final Stages
B.

Preparation and presentation of policies
Policies are often written in legal language by people with extensive

experience in that area, including lawyers and civil servants familiar with

the language of government or other institutions. Policies that are often
expressed in or with legal language include: parliamentary policy papers,
ministerial or government declarations, decrees, and statutory instru­

ments.
Policies usually go through several drafts and revisions within a national

or an organizational bureaucracy. Senior officials may want to be
required to review and comment on the drafts before they are internally
approved and finally made public. Advocacy groups may be able to see
and comment upon the draft policy.This was very much the case during

the drafting of national HIV/AIDS policies in several countries.

The public presentation of the policy may be very quiet or may receive a
lot of publicity. If a new government policy, for example, is considered
important by community groups, NGOs, businesses, religious groups, or

others, they can help organize special events to attract more public
attention. News conferences, public seminars, rallies, opinion columns in
newspapers, participation on television or radio news and interview
programs can all be used to help inform the public about the new policy
and to demonstrate support for its implementation.

C.

Implementation and oversight

A policy may exist just as it was adopted, or some clarifying rules and

regulations may be added.
The rules and regulations define how the policy will be implemented and
enforced.They may include implementation or training guidelines.
Policies can be very general or very detailed. For example, a policy can
be a simple statement of intent (’’Every citizen will have the right to full
information.“). But implementation of such a policy will require exten­
sive preparation to describe how people will have access to information,
what forms of information, the responsibilities and rights of groups that

provide information, etc.

Policy and Advocacy in HIV/AIDS Prevention
44

The Final Stages
As a policy is being implemented, you and your coalition partners will
want to assess how useful and effective the policy is.This feedback will
be very important in assuring that the problem that originally stimulated
the policy development is being addressed. Occasional contact with
people affected by the policy may be sufficient to assure that the intent
of the policy is being applied.

Organizations which adopt policies have a responsibility to regularly
monitor how the policy is being applied and implemented. At the same
time, and in the case of government, outside groups often find it useful
to monitor implementation and to regularly remind government of its
commitments.

Remember

Policy development does not stop with the adoption
of one policy or a set of policies. Action on problems
that were postponed while focusing on the priority
issue can be reconsidered. New interest groups
regularly form and will have issues which will
overlap with your own, thus stimulating collabora­
tion for policy development.
In other words, policy development is an on-going process. It’s time to
start again!

Policy and Advocacy in HIV/AIDS Prevention

45

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